Background
Neuron-specific enolase (NSE) is widely employed as a biomarker for predicting neurological outcomes in patients who remain comatose after cardiopulmonary resuscitation (CPR). Nevertheless, its prognostic accuracy in the context of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy has not been clearly established. This study aims to assess the predictive utility of NSE in patients receiving ECMO support.
Methods
Neurologic status was evaluated using the best Cerebral Performance Categories Score (CPC) during the hospital stay. Patients who deceased within the first 24 h and patients not intubated in the first 24 hours were excluded from the analysis. ROC curves were calculated to assess the discriminative ability of single NSE measurements.
Results
A total of 105 patients with full data and determination of NSE were included in the analysis. The majority of patients were male (71%) and the main cause of CPR was an acute myocardial infarction (62%). Refractory cardiac arrest was detected in 44% of the patients. 30-day mortality was 58%. NSE measurement after 48 h showed the best discrimination for poor neurological outcome (CPC 4-5, AUC of 0.84 in the ROC curve; cut-off value of 64 μg/L). Specificity was highest if NSE values increased after at 72 hours more than at 48 hour time point.
Conclusion
In post-CPR patients on VA-ECMO, NSE could be a potent mediator for assessing neurological outcome. A cut-off value of 64 μg/l was the best discrimination for poor neurological outcome, whereas specificity was maximized when NSE values still increased after 72 hours. Further research using prospective datasets is needed to verify these findings.
